Factors affecting satisfaction in patients with a rotator cuff retear: CT arthrography-based study.

PURPOSE: The relationship between retear that may occur after rotator cuff repair and patient satisfaction is not well established. This study aimed to determine whether the types and size of the retear evaluated by computed tomography arthrography (CTA) influenced patient satisfaction. We also analyzed the patient factors that could affect patient satisfaction. PATIENTS AND METHODS: A total of 50 patients who were diagnosed with rotator cuff retear after undergoing arthroscopic rotator cuff repair were included in this study. All the patients were dichotomously classified into the satisfactory or dissatisfactory groups according to the patients' self-classifications. CTA was used to assess the attachment status of the footprint, detect retear on the medial side of the footprint of the repaired cuff, and determine the retear size. Demographic factors, including sex, age, occupation, dominant upper extremity, duration of pain, presence of diabetes mellitus, trauma history, history of ipsilateral shoulder surgery, repair technique, worker's compensation status, and functional shoulder score, were investigated. RESULTS: Thirty-nine patients were classified into the satisfactory group and 11 patients were classified into the dissatisfactory group. There were no differences in age, sex, occupation, dominant hand, duration of pain, presence of diabetes mellitus, trauma history, history of ipsilateral shoulder surgery, repair technique, worker's compensation, and duration of follow-up between the two groups. However, the postoperative American Shoulder and Elbow Surgeon (ASES) score (P < 0.01), visual analog scale (VAS) pain level (P < 0.01), anteroposterior (AP) length (P < 0.01), and area of the retear site (P < 0.01) were significantly different. CONCLUSION: The AP length and area of the retear site estimated using CTA were confirmed as the significant risk factors for dissatisfaction. However, the type of repaired rotator cuff judged by the attachment status of the footprint did not correlate with patient satisfaction. In addition, the postoperative VAS pain scale and ASES score was correlated with patient satisfaction.

Relationship between the preoperative grip strength and postoperative shoulder strength of patients treated via reverse shoulder arthroplasty.

BACKGROUND: Systemic disorders including diabetes mellitus, obesity, and depression affect the outcomes of reverse shoulder arthroplasty (RSA). Sarcopenia (a general skeletal muscle disorder) is common in elderly people, but its effect on patients after RSA is not clear. We hypothesized that the preoperative sarcopenia indices of grip strength and general skeletal muscle mass would correlate with the clinical outcomes of RSA. METHODS: Grip strength and general skeletal muscle mass were measured in patients scheduled (between 2016 and 2021) for primary RSA to treat cuff tear arthropathy, an unrepairable cuff tear, or osteoarthritis with a large cuff tear. Before surgery, grip strength was measured using a hydraulic dynamometer and general skeletal muscle mass was calculated from the appendicular relative skeletal muscle mass index (aRSMI) using dual-energy X-ray absorptiometry. In all, 58 patients were included; the minimal follow-up duration was 12 months. The postoperative clinical results (pain, active range of motion, shoulder strength, and functional scores) were evaluated during scheduled outpatient visits. We calculated correlations between the preoperative sarcopenia indices, and the clinical results at the final follow-up. RESULTS: The mean preoperative grip strength and aRSMI were 21.6 ± 4.0 kg and 5.98 ± 0.84 kg/m2 in females and 30.6 ± 7.5 kg and 7.21 ± 0.94 kg/m2 in males, respectively; the grip strength and aRSMI were not associated with each other (P = .083). Ten females (25%) and 10 males (56%) met the criteria for sarcopenia. The postoperative abduction shoulder strength and Constant-Murley shoulder score increased significantly with higher preoperative grip strength (R = 0.420 and P = .001; and R = 0.497 and P < .001, respectively) and the American Shoulder and Elbow Surgeons score was related to the preoperative aRSMI (R = 0.320, P = .039). CONCLUSIONS: The shoulder strength and functional score after RSA correlated positively with the preoperative grip strength. Measuring grip strength before RSA allows the surgeon to predict shoulder strength after RSA.

Risk factors of loss of reduction after acromioclavicular joint dislocation treated with a hook plate.

BACKGROUND: Acromioclavicular joint fixation using a hook plate is effective for the treatment of acute acromioclavicular joint dislocation. However, several studies have reported some complications including loss of reduction after surgery for acromioclavicular joint dislocation. This study aimed to identify the risk factors associated with the loss of reduction after acromioclavicular joint dislocation surgery using a hook plate. METHODS: This was a retrospective study that assessed 118 patients with acromioclavicular joint dislocation, who were diagnosed between March 2013 and January 2019 and underwent surgical treatment using the hook plate (reduction loss group: n = 38; maintenance group: n = 80). The mean follow-up period was 29.9 months (range, 24-40 months). We assessed the range of motion, the American Shoulder and Elbow Surgeons score (ASES), visual analog scale score for pain, and a subjective shoulder value. Radiological assessment of coracoid clavicular distance was performed. The risk factors of reduction loss were analyzed using multivariable logistic regression analysis. RESULTS: Age (p = 0.049), sex (female, p = 0.03, odds ratio OR = 4.81), Rockwood type V (p = 0.049, OR = 2.20), and time from injury to surgery > 7 days (p = 0.018, OR = 2.59) were statistically significant factors in the reduction loss group. There were no significant differences in the clinical outcomes for range of motion, ASES, subjective shoulder value, and visual analog scale scores between the two groups. In the radiological results, preoperative coracoid clavicular distance (p = 0.039) and ratio (p = 0.001), and over-reduction (p = 0.023, OR = 0.40) were significantly different between the two groups. The multivariate logistic regression analysis identified the female sex (p = 0.037, OR = 5.88), a time from injury to surgery > 7 days (p = 0.019, OR = 3.36), and the preoperative coracoid clavicular displacement ratio of the injured shoulder (p < 0.001, OR = 1.03) as risk factors associated with reduction loss following surgery using a hook plate for acromioclavicular dislocation. CONCLUSION: A delayed timing of surgery > 7 days, preoperative coracoid clavicular displacement ratio of the injured shoulder, and female sex were identified as risk factors for loss of reduction after surgery using a hook plate for acromioclavicular joint dislocation. LEVEL OF EVIDENCE: Level IV; retrospective comparison; treatment study.

Long-term clinical outcome of tendon transfer and tendon graft for extensor tendon ruptures in rheumatoid hands.

PURPOSE: To evaluate the objective and subjective long-term clinical outcomes of tendon transfer and tendon graft for extensor tendon ruptures in rheumatoid hands. METHODS: We evaluated the long-term clinical outcomes of tendon transfer and tendon graft for extensor tendon ruptures in rheumatoid hands of 37 patients (43 hands) followed up for a mean of 14 years (range, 10-21 years). RESULTS: The mean time from rupture to surgery was 13.1 weeks (range, 3-48 weeks). The mean extension lag of the metacarpophalangeal joint was 8.7° (range, 0-40°), the mean pulp-to-palm distance was 0.4 cm (range, 0-3 cm), and the mean overall satisfaction rate was 86.5 (range, 70-100). There were no significant differences in clinical outcomes between tendon transfers and tendon grafts. There was a significant correlation between extension lag of the metacarpophalangeal joint and overall satisfaction rate (R2 = 0.155; p = 0.009). Time to surgery was significantly correlated with extension lag of the metacarpophalangeal joint (R2 = 0.437; p = 0.001) in the tendon graft group. CONCLUSIONS: Both tendon transfer and tendon graft for extensor tendon ruptures in rheumatoid hands achieve satisfactory results that are maintained for an average of 14 years. In cases of tendon graft, the time to surgery should be considered, and there is concern over extension lag of MP joint. LEVEL OF EVIDENCE: IV.

Shoulder outcome scoring systems have substantial ceiling effects 2 years after arthroscopic rotator cuff repair.

PURPOSE: Previous studies show no difference in clinical outcomes between patients with healed and structurally failed rotator cuff repairs. The objective of this study was to assess ceiling effects when reporting surgical outcomes of arthroscopic rotator cuff repair using four of the currently most popular clinical shoulder outcome scoring systems. METHODS: Ninety-two patients who underwent arthroscopic rotator cuff repair were examined. The simple shoulder test (SST), American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) shoulder rating scale, and Constant-Murley shoulder score were completed 2 years postoperatively. Demographic data of the subjects were analysed using descriptive statistics. The ceiling effects in the outcome data assessed for each scale were estimated based on two previously reported definitions. RESULTS: The number of patients with the maximum possible score was 31 (33.7%) with the SST, 26 (28.3%) with the ASES score, 28 (30.4%) with the UCLA scale, and 18 (19.6%) with the Constant-Murley score. The standardised distance of the outcome data assessed by the SST, ASES score, UCLA scale, and Constant-Murley scores were 0.92, 0.97, 0.96, and 1.18, respectively. CONCLUSION: The SST, ASES score, and UCLA scale evaluated at 2 years postoperatively have substantial ceiling effects showing that the proportion of patients with the maximum possible score is > 20%, and the standardised distance is < 1.0. Researchers should be aware of possible biases due to ceiling effects when interpreting the results of studies investigating the surgical outcomes of arthroscopic rotator cuff repair. It could increase the likelihood of a type II error. LEVEL OF EVIDENCE: IV.

National Trends in the Repair of Isolated Superior Labral Tear from Anterior to Posterior in Korea.

BACKGROUND: The optimal treatment for superior labral tear from anterior to posterior (SLAP) lesions is controversial. Thus, we aimed to investigate the national surgical trends in isolated SLAP repair in Korea. METHODS: We analyzed a nationwide database from the Korean Health Insurance Review and Assessment Service from 2008 to 2017. We investigated the trends in SLAP repair by time, sex, age, and the type of health care institution. RESULTS: From 2008 to 2017, 27,850 isolated SLAP repairs were identified. Age-adjusted incidence rate of isolated SLAP repair increased by 692% from 1.07/100,000 in 2008 to 8.48/100,000 in 2012 (P = 0.005). However, the incidence rate declined significantly after 2012 (P = 0.032) and was 5.28/100,000 in 2017. Sex-specific incidence rate of isolated SLAP repair was 2.3 times higher in men than in women. The decline since 2012 was most evident in patients aged ≥ 40 years (P = 0.01); however, the incidence rates of isolated SLAP repair during the study period were similar between patients aged ≥ 40 years and those aged < 40 years. Moreover, hospitals with 30-100 beds had the greatest change in the number of isolated SLAP repair cases. CONCLUSION: In Korea, the incidence of isolated SLAP repair increased dramatically until 2012; since then, it has declined. Although the decrease in isolated SLAP repair later in the study was evident in those aged ≥ 40 years, the incidence rate was still relatively high in patients aged ≥ 40 years.

Surgical trends in elderly patients with proximal humeral fractures in South Korea: a population-based study.

BACKGROUND: It is known that there are large regional variations in treatment methods for the management of proximal humeral fractures. The objective of this study was to investigate the national surgical trends in elderly patients with proximal humeral fractures in South Korea. METHODS: We analyzed the Korean Health Insurance Review and Assessment Service database from 2008 to 2016. International Classification of Diseases, 10th revision codes and procedure codes were used to identify patients aged ≥65 years with proximal humeral fractures. RESULTS: A total of 69,120 proximal humeral fractures were identified from 2008 to 2016. The overall operative rate for proximal humeral fractures increased steadily from 24.6% in 2008 to 36.8% in 2016 (p < 0.001). The rate of cases treated with open reduction and internal fixation tended to increase each year, from 71.5% of the overall surgeries in 2008 to 85.6% in 2016; conversely, the rate of cases treated with closed reduction and internal fixation tended to decrease from 19.9% in 2008 to 4.5% in 2016. In terms of type of arthroplasty procedure, the rate of cases treated with reverse shoulder arthroplasty tended to increase significantly each year, from 8.2% of the overall arthroplasty procedures in 2008 to 52.0% in 2016 (p < 0.001). The proportion of reverse shoulder arthroplasty was shown to increase especially in patients aged 80 years or older. CONCLUSION: Overall, our findings indicated that surgical treatment of proximal humeral fractures, particularly by open reduction and internal fixation, continues to increase; in terms of type of arthroplasty procedure, the rate of cases treated with reverse shoulder arthroplasty tended to increase.

Incidence and Seasonal Variation of Distal Radius Fractures in Korea: a Population-based Study.

BACKGROUND: The present study aimed to investigate the incidence and seasonal variation of distal radius fractures (DRFs) in Korea. METHODS: We analyzed a nationwide database acquired from the Korean Health Insurance Review and Assessment Service from 2011 to 2015. We used International Classification of Diseases, 10th revision codes and procedure codes to identify patients of all ages with newly diagnosed DRFs. RESULTS: An average of about 130,000 DRFs occurred annually in Korea. The incidence of DRF, by age group, was highest in the 10 to 14-year-old age group for males and the highest in the 70s age group for females, with a rapid increase of incidence after 50 years. The peak incidence of DRF occurred during winter; however, the incidence greatly varied annually when compared with that of other seasons. The incidence of DRFs during the winter season was correlated with the average temperature. CONCLUSION: The annual incidence of DRF was 130,000 in Korea. The incidence increased under an intense cold surge during winter. Active preventive measures are recommended especially in women exceeding 50 years considering the higher incidence in this age group.

National Trends in Surgery for Rotator Cuff Disease in Korea.

The objective of this study was to investigate the national trends in rotator cuff surgery in Korea and analyze hospital type-specific trends. We analyzed a nationwide database acquired from the Korean Health Insurance Review and Assessment Service (HIRA) from 2007 to 2015. International Classification of Diseases, 10th revision (ICD-10) codes, procedure codes, and arthroscopic device code were used to identify patients who underwent surgical treatment for rotator cuff disease. A total of 383,719 cases of rotator cuff surgeries were performed from 2007 to 2015. The mean annual percentage change in the age-adjusted rate of rotator cuff surgery per population of 100,000 persons rapidly increased from 2007 to 2012 (53.3%, P < 0.001), while that between 2012 to 2015 remained steady (2.3%, P = 0.34). The proportion of arthroscopic surgery among all rotator cuff surgeries steadily rose from 89.9% in 2007 to 96.8% in 2015 (P < 0.001). In terms of hospital types, the rate of rotator cuff surgery increased to the greatest degree in hospitals with 30-100 inpatient beds, and isolated acromioplasty procedure accounted for a larger proportion of the rotator cuff surgeries in small hospitals and clinics compared to large hospitals. Overall, our findings indicate that cases of rotator cuff surgery have increased rapidly recently in Korea, of which arthroscopic surgeries account for the greatest proportion. While rotator cuff surgery is a popular procedure that is commonly performed even in small hospitals, there was a difference in the component ratio of the procedure code in accordance with hospital type.

National Surgical Trends for Distal Radius Fractures in Korea.

The objective of this study was to investigate national surgical trends for distal radius fractures (DRFs) in Korea and analyze healthcare institution type-specific surgical trends. We analyzed a nationwide database acquired from the Korean Health Insurance Review and Assessment Service (HIRA) from 2011 to 2015. International Classification of Diseases, 10th revision (ICD-10) codes and procedure codes were used to identify patients aged ≥ 20 years with newly diagnosed DRFs. A total of 459,388 DRFs occurred from 2011 to 2015. The proportion of DRF cases treated by surgery tended to increase over time, from 32.6% in 2011 to 38.3% in 2015 (P < 0.001). Open reduction with internal fixation (ORIF) using a plate steadily gained in popularity each year, increasing from 39.2% of overall surgeries in 2011 to 60.9% in 2015. The type of surgery for DRFs differed depending on the type of healthcare institution. ORIF (91%) was the most popular procedure in tertiary hospitals, whereas percutaneous pinning (58%) was most popular in clinics. In addition, general hospitals and hospitals with 30-100 beds used external fixation more frequently than tertiary hospitals and clinics did. Overall, our findings indicate that surgical treatment of DRF, particularly ORIF, continues to increase, and that the component ratio of operation codes differed according to the healthcare institution type.

Biomechanical Properties of 3-Dimensional Printed Volar Locking Distal Radius Plate: Comparison With Conventional Volar Locking Plate.

PURPOSE: This study evaluated the biomechanical properties of a new volar locking plate made by 3-dimensional printing using titanium alloy powder and 2 conventional volar locking plates under static and dynamic loading conditions that were designed to replicate those seen during fracture healing and early postoperative rehabilitation. METHODS: For all plate designs, 12 fourth-generation synthetic composite radii were fitted with volar locking plates according to the manufacturers' technique after segmental osteotomy. Each specimen was first preloaded 10 N and then was loaded to 100 N, 200 N, and 300 N in phases at a rate of 2 N/s. Each construct was then dynamically loaded for 2,000 cycles of fatigue loading in each phase for a total 10,000 cycles. Finally, the constructs were loaded to a failure at a rate of 5 mm/min. RESULTS: All 3 plates showed increasing stiffness at higher loads. The 3-dimensional printed volar locking plate showed significantly higher stiffness at all dynamic loading tests compared with the 2 conventional volar locking plates. The 3-dimensional printed volar locking plate had the highest yield strength, which was significantly higher than those of 2 conventional volar locking plates. CONCLUSIONS: A 3-dimensional printed volar locking plate has similar stiffness to conventional plates in an experimental model of a severely comminuted distal radius fracture in which the anterior and posterior metaphyseal cortex are involved. CLINICAL RELEVANCE: These results support the potential clinical utility of 3-dimensional printed volar locking plates in which design can be modified according the fracture configuration and the anatomy of the radius.

Assessment of osteoporosis using pelvic diagnostic computed tomography.

The purpose of the present study is to determine if a correlation exists between bone mineral density (BMD) obtained from dual energy X-ray absorptiometry (DXA) and Hounsfield unit (HU) from pelvic diagnostic computed tomography (dCT), and to evaluate whether HU could be used to identify osteoporosis. Seventy-nine patients were included in this study. HU values were measured in three different sections: the head-neck junction of the femur, the middle portion of the femoral neck, and the intertrochanter of the femur (IT). In each sectional image, HU values were measured at two regions of interest: cortical and cancellous bone (HU_t) and cancellous bone. The correlation between BMD and HU_t of IT was significant (r = 0.839, p < 0.01). In IT, the area under the curve value of HU_t was 0.875 (0.796-0.955). We found that a HU_t of IT <170 can be regarded as indicating osteoporosis: its positive predictive value is 96.9 %. A HU_t of IT >210 can be regarded as indicating an absence of osteoporosis: its negative predictive value is 84.6 %. In conclusion, we found that a significant correlation between HU of pelvic dCT and BMD of DXA, and HU potentially provided an alternative method for determining regional BMD. Therefore, pelvic dCT could possibly be a supplementary method for initial diagnosis of osteoporosis and for initiation of treatment.

Surgical result of plate osteosynthesis using a locking plate system through an anterior humeral approach for distal shaft fracture of the humerus that occurred during a throwing motion.

PURPOSE: This paper analyzed outcomes of the osteosynthesis with a locking plate system for the fractures of the humerus in throwers using the anterior humeral approach. METHODS: Retrospective case series including 31 patients. Bone union was assessed through follow-up radiographs. Results of visual analogue scale (VAS) for pain, range of motion in the elbow joint, time of return to work, and the Mayo Elbow Performance Score (MEPS) were evaluated to determine functional outcomes. Direction and length of the fracture, the distal cortical length, the humeral diameter, and the total humeral length were measured as part of fracture configuration analysis. RESULTS: Mean patient age was 25.8 (range, 18-34) years. The follow-up average was 16.0 months (range, 12-23). Delayed union was observed in one (3.1 %) patient. Mean final VAS was 0.4 (range, 0-2), mean time of return to work was 18.2 weeks (range, 13-36), and mean MEPS was 96.3 (range, 88-100) points. All fractures showed a spiral configuration. Mean fracture length was 79.7 (95 % CI, 72.6-86.7) mm, and mean distal cortical length was 48.3 (95 % CI, 37.8-58.8) mm. CONCLUSIONS: The results of the current study indicates that plate osteosynthesis using a locking plate system combined with interfragmentary lag screws through anterior humeral approach may be a favorable option for the surgical treatment of humeral shaft fractures in throwers.

The medial synovial fold of the posterior cruciate ligament: cadaveric investigation together with magnetic resonance imaging and histology.

OBJECTIVE: The purposes of our study were to analyze magnetic resonance imaging (MRI) and cadaveric findings concerning the medial synovial fold of the posterior cruciate ligament (PCL) and to classify the types of fold according to anatomic location. METHODS: Two musculoskeletal radiologists reviewed MR images of 17 cadaveric knees to classify the types of medial fold of the PCL by consensus. The MRI types were divided into 3 groups. In type A, there was no definitive medial fold; and in type B, inferior-short type, there was a small protrusion of the medial border. Type C, inferior-long type, had a long enough fold to exceed the imaginary line, which is connecting between the medial tibial condyle and posterolateral aspect of the medial femoral condyle. Correlations were sought between the findings derived from the MRI studies and cadaveric dissections. Histologic analyses of the medial fold were also performed. RESULTS: On MRI, the most common type of medial fold was type B (76.4%), followed by type C (11.8%) and type A (11.8%). In the cadaveric investigation, the medial folds of both types B and C were found to project into the medial femorotibial joint. Moreover, there was also a protruding medial fold at the superior aspect of the PCL in the A. Histologic examination of the medial folds revealed collagenous tissue surrounded by synovial cells. CONCLUSIONS: Medial folds of the PCL are normal synovial structures that can be seen by MRI and in cadaveric studies in a large proportion of the population.

Ultrasonographic evaluation of the first extensor compartment of the wrist in de Quervain's disease.

BACKGROUND: This prospective cohort study was undertaken to explore the hypothesis that the retinaculum is thicker in de Quervain's disease and to identify another landmark for the presence of the intracompartmental septum. METHODS: A case group (60 wrists) comprised of Korean female patients with unilateral de Quervain's disease and a healthy control group (60 wrists) were evaluated by ultrasonography. The case group underwent surgery for extensor retinacular release, and surgical findings were used as the reference standard. The mean extensor retinacular thickness in the case and control groups was compared using a Wilcoxon rank-sum test. A receiver operation characteristic curve was constructed for the parameter. RESULTS: The mean thickness of the extensor retinaculum was 0.94 mm (SD 0.37) in the case group and 0.35 mm (SD 0.07) in the control group, and this difference was significant. The cutoff value of the extensor retinaculum for diagnosing de Quervain's disease was 0.45 mm (sensitivity 96.3%, specificity 93.3%). Bony crests were found in all cases of presence of the intracompartmental septum and could be classified into three types according to shape. CONCLUSIONS: We concluded that the extensor retinaculum is thicker in de Quervain's disease. And the bony crest on the radial styloid can be considered a new landmark for determining the presence of an intracompartmental septum. TYPE OF STUDY AND LEVEL OF EVIDENCE: Diagnostic, level II.

Surgical Trends of Shoulder Arthroplasty: Nationwide Epidemiologic Study in South Korea.

Background: The aim of this study was to determine the nationwide shoulder arthroplasty trends in South Korea based on an analysis of nationwide data acquired from the Korean Health Insurance Review and Assessment Service (HIRA). Methods: We analyzed a nationwide database acquired from the HIRA that covered 2008 to 2017. International Classification of Diseases, 10th Revision (ICD-10) codes and procedure codes were used to identify patients who underwent shoulder arthroplasty, including total shoulder arthroplasty (TSA), hemiarthroplasty (HA), and revision shoulder arthroplasty. Results: From 2008 to 2017, a total of 19,831 shoulder arthroplasties were performed; there were 16,162 TSAs and 3,669 hemiarthroplasties. During the 10-year study period, there was an exponential increase in the incidence of TSA (from 513 cases in 2008 to 3,583 cases in 2017), while the number of hemiarthroplasties remained steady. The most common diagnoses for TSA were rotator cuff tears (6,304 cases, 39.0%) and osteoarthritis (6,589 cases, 40.8%) for all 9 years. Osteoarthritis was the most common reason for TSA during the first 3 years (2008-2010), but rotator cuff tears ultimately surpassed osteoarthritis during the last 3 years (2015-2017). HA was performed to treat proximal humerus fracture (1,770 cases, 48.2%) and osteoarthritis (774 cases, 21.1%). In terms of hospital types, the rate of TSA in hospitals with 30-100 inpatient beds increased from 21.83% to 46.27%, while the rates of the other types of surgery decreased. A total of 430 revision surgeries were performed during the study period, and infection (152 cases, 35.3%) was the most common reason for revision surgery. Conclusions: Overall, the total count and incidence of TSA, unlike HA, increased rapidly between 2008 and 2017 in South Korea. Moreover, at the end of the study period, nearly half of the TSAs were performed in small hospitals (30 to 100 beds). Rotator cuff tears were the leading cause of TSA at the end of the study period. These findings revealed an explosive increase in reverse TSA surgery.

Complications and outcomes of operative treatment for acute perilunate injuries: a systematic review.

We systematically reviewed the incidence of complications and outcomes of different surgical methods for acute perilunate injury in the MEDLINE, Scopus, Embase and Cochrane Library databases. Forty-three articles with 880 patients were included. The most common complications were arthritis (30%), carpal instability (15%), avascular necrosis of the lunate (12%), complex regional pain syndrome (11%), and nonunion or avascular necrosis of the scaphoid (9%). In the meta-analysis, the mean scapholunate gap was 1.7 mm in the closed surgery group and 2.3 mm in the open surgery group, which was a statistically significant difference. The mean flexion-extension arc of the wrist and modified Mayo wrist score were better in the closed surgery group than in the open surgery group. However, these findings may relate to different cohorts in terms of injury severity. Therefore, the causal relationship between closed surgery and better outcomes may be uncertain as less severe subluxations are more likely to be treated closed.

Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repair: aggressive versus limited early passive exercises.

PURPOSE: To compare range of motion and healing rates between 2 different rehabilitation protocols after arthroscopic single-row repair for full-thickness rotator cuff tear. METHODS: Sixty-four shoulders available for postoperative magnetic resonance imaging (MRI) evaluation after arthroscopic rotator cuff repair were enrolled in this study. Aggressive early passive rehabilitation (manual therapy [2 times per day] and unlimited self-passive stretching exercise) was performed in 30 shoulders (group A) and limited early passive rehabilitation (limited continuous passive motion exercise and limited self-passive exercise) in 34 shoulders (group B). A postoperative MRI scan was performed at a mean of 7.6 months (range, 6 to 12 months) after surgery. RESULTS: Regarding range of motion, group A improved more rapidly in forward flexion, external rotation at the side, internal and external rotation at 90° of abduction, and abduction than group B until 3 months postoperatively with significant differences. However, there were no statistically significant differences between the 2 groups at 1-year follow-up (P = .827 for forward flexion, P = .132 for external rotation at the side, P = .661 for external rotation at 90° of abduction, and P = .252 for abduction), except in internal rotation at 90° of abduction (P = .021). In assessing the repair integrity with postoperative MRI scans, 7 of 30 cases (23.3%) in group A and 3 of 34 cases (8.8%) in group B had retears, but the difference was not statistically significant (P = .106). CONCLUSIONS: Pain, range of motion, muscle strength, and function all significantly improved after arthroscopic rotator cuff repair, regardless of early postoperative rehabilitation protocols. However, aggressive early motion may increase the possibility of anatomic failure at the repaired cuff. A gentle rehabilitation protocol with limits in range of motion and exercise times after arthroscopic rotator cuff repair would be better for tendon healing without taking any substantial risks. LEVEL OF EVIDENCE: Level II, randomized controlled trial.

Effect of the Articular Surface Incongruency on Surgical Outcome of the Distal Radius Fracture.

Purpose: The aim of this study was to demonstrate the joint fragment that mostly affects the outcome of the distal radius fracture surgically treated with a volar locking plate (VLP). Methods: The outcomes of 69 patients with the distal radius fractures were evaluated at their final follow-up. The articular surface was divided into six specific fragments, and computed tomography (CT) was used to evaluate the degree of mismatch of each fragments. A plain radiograph was also obtained for evaluation of the distal radius alignment. Clinical outcomes were measured by using the Disabilities of the Arm, Shoulder and Hand (DASH) and Modified Mayo Wrist Score (MMWS). Univariate analyses were performed, with subsequent multiple logistic regression analyses. Results: The mean follow-up period was 14.8 (range, 12 to 52) months. The group with a worse DASH score showed significantly greater mismatch in the volar and dorsal lunate facets, as well as the central depression of the distal radius (p = 0.042, 0.031, and 0.023, respectively). There was a significant positive correlation between the DASH score and degree of mismatch of the dorsal lunate facet and central depression of the distal radius (p = 0.040 and 0.011, respectively). Groups with worse MMWS showed significantly greater mismatch in the dorsal lunate facet (p = 0.025). There was a significant negative correlation between MMWS and abnormal ulnar variance and mismatch of the dorsal lunate facet and central depression of the distal radius (p = 0.041, 0.004, and 0.018, respectively). The result of multiple logistic regression analysis demonstrated that a mismatch of the dorsal lunate facet is a significant predictor for a worse MMWS (odds ratio = 3.072, p = 0.043). Conclusions: Articular surface mismatch of the dorsal lunate facet appears to mostly affect the surgical outcomes of the distal radius fractures using VLP. In cases where the dorsal lunate facet is heavily involved, surgeons should be cautious about its reduction and fixation.